How Giacomo Got Back on Track After an ACL Tear

It was supposed to be a training day like any other when professional racer Giacomo jumped on a friend's motorcycle to see how it rode. He made the same turn he’d made several times that day, but this time he hit the turn just a little differently—and that one small change made all the difference in the world.

Giacomo recalls, “I compressed the bike into the berm, into the ground and I had my leg out there. It was just in a bad spot, and it twisted itself up, and I tore my ACL.”

But his accident took another surprising turn when Giacomo didn’t have the typical response one might expect after such a potentially devastating injury.

“It’s not really funny,” he says, “but still, the funnier side of this was that I instantly got up and I sat on the truck and was like, ‘No, I'm fine. I just probably hyperextended my knee a little bit.’”

He went to his doctor, but he still didn’t realize he’d torn his anterior cruciate ligament (ACL). He had a swollen knee, which didn’t alarm him. But an exam revealed an ACL tear. After further discussion, the doctor told Giacomo he’d see him at the next checkup and go from there.

“The approach we took was, let's wait on surgery because I was doing so well. We'll wait, and then we can see if we can rehabilitate. The problem was that my doctor never put enough emphasis on rehabilitation. I did some exercises for maybe a month or two at home. And that was it.”

Giacomo moved on with this life, saying, “We ended up leaving it for two years. And I even won a championship race with a torn ACL.”

Giacomo took a torn ACL in stride because falls, injuries and scrapes have been a constant throughout his life and career. As a kid, he loved racing his bicycle everywhere he could. Competing with his friends around the streets of Italy cemented his plan to race professionally when he was older, whether on a bicycle, dirt bike or motorcycle.

“I ended up choosing motorcycles over bicycles,” he says, noting that he began riding motorcycles over 10 years ago. He moved from Italy to the U.S. in 2017 and began to compete professionally on national and international courses about five years ago.

“I've broken both of my collarbones a year apart from each other,” he says.

“The other pretty big accident was when I was thrown off my bike going 120-something miles an hour. I completely tore my leather suit and had a lot of skin missing from my back and hands.”

Despite other crashes within two years after his ACL injury, Giacomo continued to race.

Then came a wet day two years after his ACL injury. “The one that did it for me was last year at the MotoAmerica race at Barber,” he says. “I crashed [because of the wet road] and I hit the curb in a weird spot. My leg got stuck somehow underneath the bike. And when I twisted it, I felt my knee pop out. I knew I needed to get this thing fixed because if it keeps happening, it won’t be good.”

A fellow racer recommended Richard Danilkowicz, MD, an orthopaedic sports medicine surgeon at Emory Healthcare who specializes in shoulder, elbow and knee conditions. The racer told Giacomo that he had gone to Emory for several surgeries, and it was one of the best places he'd ever been.

“It was time to get a second opinion and see what we can do,” says Giacomo. “Based on the recommendation and my research, I decided to meet with Dr. Danilkowicz. He told me I definitely needed surgery and what the recovery time was going to be. And I thought, I'll suck it up. It's winter, so we can make this happen.

Dr. Danilkowicz describes Giacomo’s injury as a standard ACL tear. “But these tears do not heal themselves,” he says. “His injury was interesting, not because the tear itself was abnormal, but because he had sustained the injury two years before coming to my clinic. He was still operating at a very high level in his sport, despite having this lack of ACL for two years.”

According to Dr. Danilkowicz, most people have reconstructive surgery for their ACL. “We take tissue either from the patient themselves or, with older patients, we'll often use donor tissue to reconstruct the ACL."

For athletes like Giacomo, surgeons prefer to use the patient’s own tissue. There are several options, whether it's the hamstrings, patellar tendon or quadriceps tendon. Each has its risks and benefits. Dr. Danilkowicz tailors the choice to the patient—not just to the data he has from research but also to the athlete’s activities and movements. The goal is to avoid negatively impacting the athlete’s specific sport and its demands.

Dr. Danilkowicz sees his role as providing objective data and research. “At the end of the day, the patient and I share decision-making about what the patient is most comfortable with,” he says. “After getting all the information, Giacomo went with the quadriceps tendon graph, which, for his sport and activity, made the most sense for him.”

The surgeon took a strip of the quadriceps tendon just above Giacomo’s kneecap and made a new ACL out of it. He reconstructed the ACL by drilling tunnels in the bones and making small incisions. Over time, Giacomo’s body will turn the quadricep tendon into his ACL—it will heal into the bone and become a ligament. 

A Seamless Recovery in South Carolina

For Giacomo, who lives in Greenville, South Carolina, one of the biggest benefits of working with Dr. Danilkowicz and the team at Emory Healthcare was that, although the surgeon is in Atlanta, Giacomo still received top-notch care during his recovery.  

 “They offer a really good program at Emory for physical therapy,” he says. “But because I was out of state, it was just not doable for me to go to Atlanta twice a week. They worked with me to stay with my local physical therapist, who I've worked with in the past.” 

 Dr. Danilkowicz partnered with Giacomo’s physical therapist to guide and assess his ACL rehabilitation, and checked in with Giacomo via phone calls and video visits.  

“That’s one thing that made me want to go with Emory,” says Giacomo. “It was really good to have him say, ‘You're far away. We can communicate in other ways and share information.’” 

 For his part, Dr. Danilkowicz wants the recovery process to be as smooth as possible. “From a follow-up standpoint, we try to make it easy on anyone who travels a distance. We make sure we see him at certain time points in the recovery when we need a hands-on evaluation.  

Between those, phone calls and video visits, getting Giacomo in for follow-ups in has been seamless.” 

According to Dr. Danilkowicz, recovery from ACL surgery for most people takes about a year. “I tell my patients that, best-case scenario, if everything goes great, it's nine months, not any sooner than that,” he says. “The data in our field is pretty convincing that nine months is the minimum. It’s biology. Your body needs to heal from this surgery. There are things we can't rush.”

Patients’ commitment to rehabilitation also plays a major role in recovery, especially when they’re working back toward returning to a sport.

“I always tell the patients that my part is the easy part, and then they do the work,” says Dr. Danilkowicz. “We operate for 60 to 90 minutes, and Giacomo has nine to 12 months of work.”

Giacomo has stayed focused on his recovery. “Initially, it was a lot just to get the knee to bend and get used to having a new ACL. But after a couple of weeks, I was already walking. We also started doing a lot of strength training in the second month. Obviously, just very light stuff, but strength training, lots of cardio and then getting back to running.”

His recovery had the extra challenge of his body being dependent on the non-injured leg the past two years. “

The torn ACL was in my left leg, which made my right leg work twice as hard the last two years. My body just kind of ‘forgot’ that I have a left leg. I had to, let's say, make myself understand that I have a left leg and I need to use it. That was the biggest issue.”

Dr. Danilkowicz says, “Giacomo has been incredibly diligent and hardworking from the start. He’s hit every milestone necessary and has had a pretty optimal recovery to this point. It reflects on his work ethic that he’s passed every milestone with flying colors.”

Giacomo plans to race again as soon as possible. “I can't wait,” he says with a smile.